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Group A streptococcal disease in paediatric inpatients: a European perspective

Lookup NU author(s): Professor Marieke Emonts-le ClercqORCiD

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Springer Nature, 2023.

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Abstract

© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. Group A streptococcal (GAS) disease shows increasing incidence worldwide. We characterised children admitted with GAS infection to European hospitals and studied risk factors for severity and disability. This is a prospective, multicentre, cohort study (embedded in EUCLIDS and the Swiss Pediatric Sepsis Study) including 320 children, aged 1 month to 18 years, admitted with GAS infection to 41 hospitals in 6 European countries from 2012 to 2016. Demographic, clinical, microbiological and outcome data were collected. A total of 195 (61%) patients had sepsis. Two hundred thirty-six (74%) patients had GAS detected from a normally sterile site. The most common infection sites were the lower respiratory tract (LRTI) (22%), skin and soft tissue (SSTI) (23%) and bone and joint (19%). Compared to patients not admitted to PICU, patients admitted to PICU more commonly had LRTI (39 vs 8%), infection without a focus (22 vs 8%) and intracranial infection (9 vs 3%); less commonly had SSTI and bone and joint infections (p < 0.001); and were younger (median 40 (IQR 21–83) vs 56 (IQR 36–85) months, p = 0.01). Six PICU patients (2%) died. Sequelae at discharge from hospital were largely limited to patients admitted to PICU (29 vs 3%, p < 0.001; 12% overall) and included neurodisability, amputation, skin grafts, hearing loss and need for surgery. More patients were recruited in winter and spring (p < 0.001). Conclusion: In an era of observed marked reduction in vaccine-preventable infections, GAS infection requiring hospital admission is still associated with significant severe disease in younger children, and short- and long-term morbidity. Further advances are required in the prevention and early recognition of GAS disease.What is Known:• Despite temporal and geographical variability, there is an increase of incidence of infection with group A streptococci. However, data on the epidemiology of group A streptococcal infections in European children is limited.What is New:• In a large, prospective cohort of children with community-acquired bacterial infection requiring hospitalisation in Europe, GAS was the most frequent pathogen, with 12% disability at discharge, and 2% mortality in patients with GAS infection. • In children with GAS sepsis, IVIG was used in only 4.6% of patients and clindamycin in 29% of patients.


Publication metadata

Author(s): Boeddha NP, Atkins L, de Groot R, Driessen G, Hazelzet J, Zenz W, Carrol ED, Anderson ST, Martinon-Torres F, Agyeman PKA, Galassini R, Herberg J, Levin M, Schlapbach LJ, Emonts M, EUCLIDS Consortium

Publication type: Article

Publication status: Published

Journal: European Journal of Pediatrics

Year: 2023

Volume: 182

Pages: 697-706

Print publication date: 01/02/2023

Online publication date: 30/11/2022

Acceptance date: 14/11/2022

Date deposited: 01/02/2023

ISSN (print): 0340-6199

ISSN (electronic): 1432-1076

Publisher: Springer Nature

URL: https://doi.org/10.1007/s00431-022-04718-y

DOI: 10.1007/s00431-022-04718-y

ePrints DOI: 10.57711/sbjx-tv52


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Funding

Funder referenceFunder name
279185
342730_153158/1
Bangerter Foundation
European Seventh Framework Programme for Research and Technological Development (FP7)
Foundation for the Health of Children and Adolescents
Swiss National Science Foundation
Swiss Society of Intensive Care
Vinetum and Borer Foundation

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